Eczema – Medical Disability Guidelines

History: The most common complaint of eczema is itchiness (pruritus), redness, and tiny bumps or blisters. If untreated, the skin can become thick, scaly, and dry, with areas of hair loss and color changes. The individual may relate a history of work or recreational activities in which the skin is exposed to water, moisture, sun, or new personal care products.

Physical exam: In general, eczema presents with redness, warmth, swelling (edema), tenderness, weeping, crusting, scratches and cracks (excoriations), and thickened and scaling skin with a diffuse border.

Skin changes associated with atopic dermatitis are variable and include excoriations; wet, raised bumps (papules); thickened, red, gray, or scaly skin (lichenification); red, fluid-filled bumps (vesicles); and crusted lesions.

Contact dermatitis presents as areas of reddened (erythematous) and swollen (edematous) skin that later develop small and large blisters (vesicles and bullae, respectively). The pattern, shape, and location of the contact dermatitis rash help identify the causative substance. Hand eczema may present with dryness and cracking of the skin, with some redness and swelling. A variation of this condition, dyshidrotic eczema, has small, very itchy bumps along the fleshy parts of the palms and sides of the fingers. Nummular eczema has round scaly patches that look similar to ringworm and are found on the trunk, the back of the arms and hands, and the shins. Stasis dermatitis often exhibits dark red discoloration and swelling of the skin on the lower leg, ankle, and top of the foot. Stasis dermatitis lesions can become irritated and inflamed and in many cases can result in skin ulcers.

Asteatotic eczema (winter itch) presents with fine cracks over the front surface of the thighs and shins and possibly a dry, shiny appearance. Scabies presents with the classic eczematous lesions found primarily on the ankles, webs of fingers and toes, scalp, wrists, bellybutton (umbilicus), genitals, or the nipples. Seborrheic dermatitis presents as red, itchy, scaly areas, primarily on the face, scalp, groin, anogenital region, and/or below the breasts. Lichen simplex chronicus is a late stage of eczema and consists of thickened, scaly skin due to chronic rubbing or scratching. Common areas for lichen simplex chronicus are the back of the neck, tops of the feet, and ankles.

Tests: Though most eczemas are diagnosed through the history and physical exam, a scraping of the lesion should be examined under the microscope to rule out certain other skin disorders. Skin biopsy is done when persistent eczema does not respond to treatment. Skin patch tests, provocative challenges, and some immunological testing may be required. Elevated total IgE denotes an underlying allergy.

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Eczema - Medical Disability Guidelines